Al-Qahtani Hamad H, Alam Mohammed K, Al-Akeely Mohammed H, Al-Salamah Saleh M
Department of Surgery, College of Medicine, King Saud University, PO Box 7805, Riyadh 11472, Kingdom of Saudi Arabia.
Saudi Med J. 2011 Jul;32(7):714-7.
To determine the long term outcome of cholecystectomy without intraoperative cholangiogram (IOC) in patients recovering from acute gallstone pancreatitis with normal preoperative liver function tests and imaging.
The medical records of all patients who underwent cholecystectomy without IOC for gallstone pancreatitis at King Saud Medical City, Riyadh, Saudi Arabia between January 2005 and December 2009 were studied retrospectively. Patients with severe pancreatitis and those who had preoperative endoscopic retrograde cholangio-pancreatography (ERCP) were excluded from the study. Data on patients' demography, symptoms, laboratory findings, intraoperative and postoperative findings, length of hospital stay, and outpatient follow up were collected and analyzed.
A total of 160 patients were treated for acute gallstone pancreatitis. Forty-four patients with preoperative ERCP (n = 39), and severe pancreatitis (n = 5), were excluded. The remaining 116 patients initially underwent conservative treatment followed by cholecystectomy without IOC. All were followed up for an average of 2-4 visits. Five patients (4.3%) were re-admitted with gallstone related bilio-pancreatic complications. They underwent ERCP and CBD stone clearance. Four patients were lost to follow up. The remaining 107 patients have remained asymptomatic 12-55 months after cholecystectomy.
The incidence of bilio-pancreatic complications from unsuspected CBD stones in patients of biliary pancreatitis that underwent cholecystectomy without IOC is very low. Therefore, a routine IOC in these patients can be omitted safely.
确定在术前肝功能检查和影像学检查正常的急性胆石性胰腺炎康复患者中，未进行术中胆管造影（IOC）的胆囊切除术的长期结果。
回顾性研究2005年1月至2009年12月在沙特阿拉伯利雅得国王沙特医疗城因胆石性胰腺炎接受无IOC胆囊切除术的所有患者的病历。排除重症胰腺炎患者和术前接受内镜逆行胰胆管造影（ERCP）的患者。收集并分析患者的人口统计学、症状、实验室检查结果、术中及术后检查结果、住院时间和门诊随访数据。
共有160例患者接受急性胆石性胰腺炎治疗。排除44例术前接受ERCP的患者（n = 39）和重症胰腺炎患者（n = 5）。其余116例患者最初接受保守治疗，随后接受无IOC的胆囊切除术。所有患者平均随访2 - 4次。5例患者（4.3%）因胆石相关的胆胰并发症再次入院。他们接受了ERCP和胆总管结石清除术。4例患者失访。其余107例患者在胆囊切除术后12 - 55个月无症状。
在未进行IOC的胆囊切除术中，胆源性胰腺炎患者未被怀疑的胆总管结石引起的胆胰并发症发生率非常低。因此，这些患者可安全地省略常规IOC。
